The government’s budget delivered more new funding for the NHS than many observers had expected but far less than needed to avoid further restrictions on services.1 At its recent board meeting, NHS England discussed the implications of the budget and considered a paper that started from the premise that “with its 2018-19 budget the NHS will likely not be able to do everything being expected of it. This will therefore require realism and some difficult judgements about priorities.”2

NHS England’s view is that commissioner and provider deficits should be the first call on the additional £1.6bn revenue funding for 2018-19 announced in the budget, followed by planned investment in mental health, cancer, and primary care. Beyond that, the paper presented to its board argued that new advisory NICE guidelines could be implemented if accompanied by a clear affordability and workforce assessment, but waiting time …